Diarrhoea, constipation, gastroenteritis Flashcards
Definition of diarrhoea
How is diarrhoea divided based on duration?
An increase in stool liquidity and/or increase in stool frequency.
<14 days = acute
>4 weeks = chronic
How is constipation commonly described?
When is constipation classed as chronic?
It is commonly described as incomplete emptying, excessive straining or reduced stool frequency (<3 times/week).
Constipation persisting >6weeks is termed chronic constipation.
Red flag symptoms for constipation
- Obstructive symptoms
- Weight loss
- PR bleeding
- Recent onset constipation
- Iron deficiency anaemia
- Age >50 without any previous cancer screening
Causes of acute diarrhoea
- Infective
- Gastroenteritis
- C. diff colitis
- Drug induced
- Antibiotics
- PPIs
- NSAIDs
- Digoxin
- Bloody
- Dysentry
- Acute flare of IBD
- Diverticulitis
- Ischaemic colitis
Classes of causes of chronic diarrhoea
- Functional (IBS)
- Inflammatory
- IBD
- Chronic mesenteric ischaemia
- Chronic infection
- Watery
- Fatty
Causes of watery diarrhoea
- Osmotic
- Dietry intolerance eg lactose, gluten
- Laxative overuse
- Secretory
- Bile acid malabsorption
- Microscopic colitis
- Hyperthyroidism, hypercalcaemia
- Colorectal cancer
Causes of fatty diarrhoea
Malabsorption disorders, eg SIBO, chronic pancreatitis, Whipple disease
Classes of causes of constipation
- Structural
- Normal transit
- Slow transit (motility disorder)
- Evacuation disorder
- Secondary constipation (including drugs)
Structural causes of constipation
- Diverticular disease
- Colorectal cancer
- Strictures (eg Crohn’s)
- Extrinsic compression, eg pelvic mass
Normal transit causes of constipation
- Irritable bowel syndrome
- Psychological - depression, anxiety associated constipation
Slow transit (motility disorder) causes of constipatation
- Post-op ileus
- Chronic intestinal pseudo-obstruction
- Hirschprung disease
- Neuromuscular disorders, eg MS, Parkinson disease, diabetic neuropathy
Evacuation disorder causes of constipation
- Ano-rectal conditions eg rectal prolapse, anal fissure
- Pelvic floor dysfunction
Causes of secondary constipation
- Low dietary fibre
- Inadequate hydration
- Immobility, old age
- Metabolic - hypothyroidism, hypercalcaemia, uraemia
- CKD
- Pregnancy
- Drugs
Medications which can cause constipation
- Opiates
- Anticholinergics eg TCA
- Calcium channel blockers
- Iron supplements
- Antidepressants
- Antacids
What is gastroenteritis?
Gastroenteritis is a non-specific term used to characterise symptoms of acute diarrhoea, nausea and vomiting and abdominal pain.
Name some causitive agents of gastroenteritis
- Bacterial
- Campylobacter jejuni (most common bacteria cause)
- E. coli O157
- Salmonella
- Viral (30-40%)
- Norovirus
- Rotavirus
- Parasties
- Giardiasis
- Cryptosporidiosis
Campylobacter jejuni source of infection
- Contaminated water
- Animal droppings
- Unpasteurised milk
Campylobacter jejuni clinical features
Fever and dysentry
Campylobacter jejuni complications
- Guillain-Barre syndrome (seen in up to 10% of patinets)
- Reactive arthritis
Campylobacter jejuni gastroenteritis management
- Self limiting in the first 7 days
- More severe forms may respond to erythromycin
Salmonella spp. source
- Contaminated water
- Eggs, poultry, meat
Salmonella spp. gastroenteritis clinical features
- Dysentery and vomiting
- Abdominal pain
- Low grade fever
Salmonella spp. gastroenteritis complications
Reactive arthritis
Salmonella spp. gastroenteritis management
- Usually self limiting
- Ciprofloxacin may be used if there is bacteraemia
E. coli O157 source
Contaminated food products, usually occurs as outbreaks
E. coli O157 gastroenteritis clinical features and complication
Dysentry and constant abdo pain
Cx: haemolytic uraemic syndrome (HUS)
E. coli gastroenteritis management
- Supportive as antibiotic therapy may worsen symptoms
- Haemodialysis if necessary
Source of norovirus and rotavirus
Norovirus - common in adults
Rotavirus - common in children
Clinical features of norovirus
- Profuse watery diarrhoea, projectile vomiting
- Colicky abdominal pain
Clinical features of rotavirus
Watery diarrhoea and vomiting
Managment of norovirus and rotavirus
Self limiting, contact precaution
Giardia lamblia source
- Contaminated water
- Common in the tropics
Giardia lamblia clinical features
- Explosive, offensive diarrhoea and vomiting
- Abdominal pain and distension
Giardia lamblia management
Tinidazole stat and metronidazole for 10 days
Cryptosporidiosis source
- Only seen in immunocompromised patients
- Contaminated water
Cryptosporidiosis clinical features
- Profuse diarrhoea
- Intermittent abdominal pain
Cryptosporidiosis management
- Usually self limiting
- If severe, co-trimoxazole for 7 days
